Initial characteristics and course of disease in patients with suspected COVID-19 managed in general practice: a prospective, multicentre cohort study

Abstract

ObjectivesTo describe and compare the initial clinical characteristics of a cohort of patients with suspected COVID-19 managed by general practitioners (GPs); to assess whether 3-month persistent symptoms were more frequent among confirmed cases than among no-COVID cases; and to identify factors predictive of persistent symptoms and adverse outcomes among confirmed cases.Design and settingA comparative, prospective, multicentre cohort study in primary care in the Paris region of France.Participants521 patients aged ≥18 with suspected COVID-19 were enrolled between March and May 2020.Outcome measuresInitial symptoms, COVID-19 status, persistent symptoms 3 months after inclusion and a composite criterion for potentially COVID-19-related events (hospitalisation, death, emergency department visits). The final COVID-19 status (‘confirmed’, ‘no-COVID’ and ‘uncertain’ cases) was determined by the GP after the receipt of the laboratory test results.Results516 patients were analysed; 166 (32.2%) were classified into the ‘confirmed COVID’ group, 180 (34.9%) into the ‘no-COVID’ group and 170 (32.9%) in the ‘uncertain COVID’ group. Confirmed cases were more likely to have persistent symptoms than no-COVID cases (p=0.09); initial fever/feeling feverish and anosmia were independently associated with persistent symptoms. At 3 months, we observed 16 (9.8%) COVID-19-related hospital admissions, 3 (1.8%) intensive care unit admissions, 13 (37.1%) referrals to an emergency department and no death. Age >70 and/or at least one comorbidity (OR 6.53; 95% CI 1.13–37.84; p=0.036), abnormalities in a lung examination (15.39; 95% CI 1.61–146.77; p=0.057) and two or more systemic symptoms (38.61; 95% CI 2.30–647.40; p=0.011) were associated with the composite criterion.ConclusionsAlthough most patients with COVID-19 in primary care had mild disease with a benign course, almost one in six had persistent symptoms at 3 months. These symptoms were more frequent in the ‘confirmed COVID’ group. Our findings need to be confirmed in a prospective study with longer follow-up.